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The California Gold Exchange Plan

Quick tips on the Anthem Blue Cross of California Clear Protection PPO Plan
Clear Protection Plans in California 2nd richest Exchange Plan is still plenty rich (detail below)
Anthem Blue Cross Clear Protection 3300 The Gold Plan will likely have no deductible
Clear Protection 3300
Subsidies are NOT available for the Gold health plan
Clear Protection 3300 Quote the California Gold Plan starting October 1st, 2013

NEW!  California Health Subsidy Calculator  (until we have exact rates October 1st, 2013)

We now have a basic layout for the Gold Health Exchange plan in California and its benefits definitely befit the name.  The Gold plan is second from the top (Platinum) and above the two other Metallic plans (Silver and Bronze) so in theory, it should equate to an upper tier plan on the current market.  In fact, the Gold plan is much richer than anything we currently have on the market so it will be interesting to see how it fares in the new marketplace.  Let's take a look at the core benefits as layed out by the California Exchange.  Keep in mind that each carrier might have small adjustments up or down to the core benefits but only by a few percentage points by law.  A link to the actual benefits will be below.

The Gold Exchange plan core benefits.  Keep in mind that the State actually described two different versions of the Gold plan;  a Copay option and a Coinsurance option.

Gold Plan Deductible

This was our biggest surprise when looking at the California Gold Plan benefits.  It was still (same with Platinum) a no-deductible plan.  We fully expected a $250-500 deductible which is richer than anything we currently have on the individual family market(although in line with Group's richest plans).  We haven't had PPO no deductible plans on the individual family market for almost 10 years now due to the cost.  Of course, with no subsidy available for the Gold (only Silver has subsidy), cost is still king so it will be interesting to see how the Gold fares.

Gold Exchange Plan Max out of Pocket and Coinsurance

The second most important piece of a health plan is the OOP or Out of Pocket max which describes a plan's protection from the really big bills.  The Gold Plan OOP is $6400 for both options (copay or coinsurance).  How you get there differs according to which option you choose.  They both work as 80/20 plans (you pay 20% till OOP) but the copay option brings fixed copay amounts for certain benefits such as $600/daily for hospital up to 5 days.  Keep in mind that one night in a hospital can be $20-30K so the copay plan will likely have big hits unless it is wrapped in the HMO model's cost containment ability. 

Gold Plan Office and RX Copays

The Gold plan with have a $45 copay for primary care visits and a $65 for specialist.  Preventative benefits will be covered at 100% (as with current plans) in-network.  For presciptions, Generic copays are $25, Brand formulary are $50, and Brand non-formulary are $70.  There is no deductible for medications which is a huge departure from current health plans.

Diagnostic Lab, X-ray, and Imaging on the California Gold Exchange Plan

Diagnostic Lab will have a $45 copay on either option.  X-ray will have a $65 copay.  Imaging (think MRI's, Cat Scans, etc) will have a 20% coinsurance or $250 copay depending on the plan selection.  

Gold Plan Pricing and Future

It all comes down to price.  Keep in mind that the generous subsidies will only be available on the California Silver Exchange plan.  The Platinum, Gold, and Bronze need to fare for their own based on merit.  That's going to be tough for the Platinum and Gold which are both much richer than what anyone buys today on the market.  There's a reason those plans don't exist now in the market.  If you can save $2K annually by adding $2K to your deductible, most people will take that trade-off.  Only the unhealthy will now which furthers that price spread into future years.  We see limited uptake by the public for the Platinum or Gold and estimate the Silver (subsidy) and Bronze (non-subsidy but lowest priced) plans dominate the California Exchange market with 90%+ share.  Time will tell very shortly.

California Gold Health Plan Benefits

Related Pages:

California release core Metallic Benefit detail
Why the Silver Plan Matters
Penalties for not purchasing California health insurance
Subsidies to help buy California health coverage
Introduction to the California health exchange





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